There have long been disparities in health outcomes between Ohioans of color and white Ohioans, with yearly widening gaps in infant mortality rates, average life expectancy rates, maternal mortality rates and more. Minority health in Ohio has long suffered from poor social determinants of health due to policy and system inequities. The COVID-19 pandemic is highlighting these inequities, as we can see Black Ohioans disproportionately make up a large percentage of confirmed COVID-19 cases, hospitalizations and fatalities. Unfortunately, this trend is consistent around the country where several racial and ethnic minority groups are disproportionately affected by COVID-19. This can be attributed to many factors including that they are more likely to have essential jobs, are more likely to have chronic health conditions with inconsistent access to health care and are more likely to suffer from educational, income and wealth gaps.[1] Still, the disparities are alarming and need to be addressed as minorities comprise of 21 percent of Ohio’s population.[2]
Governor Mike DeWine formed the COVID-19 Minority Health Strike Force early in the pandemic to work alongside state leadership to develop urgent, concrete steps that can be taken to lessen the impact of COVID-19 on Ohioans of color.
Governor Mike DeWine formed the COVID-19 Minority Health Strike Force early in the pandemic to work alongside state leadership to develop urgent, concrete steps that can be taken to lessen the impact of COVID-19 on Ohioans of color. The Director of RecoveryOhio, Alisha Nelson and Director of the Ohio Department of Aging, Ursel McElroy, were selected to serve as co-chairs of the Strike Force. The rest of the strike force is comprised of professionals of color from across the state and across sectors including health care, government, religious institutions, nonprofits and academia. Members were then divided into four subcommittees including health care; resources; education and outreach; and data and research. Over the past several months, these committees met, analyzed data, gathered input from community members and heard testimony from organizations including Community Solutions to develop actionable recommendations for the recently released blueprint.
The blueprint contains 35 recommendations, divided into categories, that will serve as a roadmap for the DeWine administration to advance health equity during the pandemic and onward.
Many of the recommendations we found to be sound, clear and reasonable. If they are consistently adopted on the state level, they will have a trickle-down effect to public health and human service organizations statewide including nonprofits and the private sector. Here at Community Solutions, we have committed ourselves to many of the recommendations that aim to “dismantle racism to advance health equity” such as acknowledging racism as a public health crisis and applying a health equity lens to policy.
National Culturally and Linguistically Appropriate Services Standards should be utilized and mandated in other institutions beyond the state, such as city and county health departments.
Recommendation five, require cross-sector cultural and linguistic competency and implicit bias trainings, was a large part of our testimony to the committee. Community Solutions’ policy team continually stresses the importance of culturally competent providers and policymakers as a major key to ensure positive health outcomes for Ohioans of color. However, we also believe the National Culturally and Linguistically Appropriate Services (CLAS) Standards should be utilized and mandated in other institutions beyond the state, such as city and county health departments. Further, we have examined studies that reveal significant bias among medical students that have resulted in inferior and inappropriate treatment recommendations, poor outcomes and reduced trust and communication with patients. Because of this, we think it is crucial that all of Ohio’s eight medical schools adopt CLAS-informed curricula to help students recognize, critically assess and lessen systemic implicit biases as a foundational aspect of their medical education and professional responsibilities.
Other recommendations we would like to elevate include:
- Integrate behavioral health into primary care – Enhancing behavioral health access remains one of our policy priorities because we recognize through our By the Numbers series, our jail diversion report and other research that there are mental and behavioral health service disparities in racial, ethnic and geographical populations in our diverse state. By prioritizing integrating behavioral health into primary care, coupled with ongoing education and training, we can ensure a reduction in disparities that underserved populations face and offer cultural and linguistically competent programs and services.
- Develop a health and criminal justice partnership – Through research on jail diversion programs across the country we determined that pre-arrest jail diversion is a model that communities across the state should explore. The goal for jail diversion is to not only avoid costly booking and drawn out, expensive hearings for low-level crimes, but also to ensure people in our communities, particularly people of color who are overrepresented in the criminal justice system, have access to help and resources. What we learned, however, is that pre-arrest jail diversion does not work without a health and criminal justice partnership.
- Explore options to expand broadband funding to ensure Ohioans of color have sufficient internet access and bandwidth for education and telehealth activities – The pandemic has required a shift in the way we access vital services such as health appointments, grocery shopping and even school. Unfortunately, because of the digital divide, and varying levels of technological and digital literacy and availability, the shift to remote delivery of services will leave certain groups even further behind.
- Improve data collection and reporting – Throughout our commitment to developing policies that will improve maternal and infant health in our state, we have encountered several barriers not only because of lack of data but also because of lack of recent data. Improving data collection will aid in identifying and reflecting gaps in clinical and social supports and help to improve health outcomes for all Ohioans.
- Increase public access to data and support research – Of the data currently collected, much of it is only available through a lengthy public records request process. Because disaggregated data can be sensitive, we understand why this process is necessary in some cases. However, increasing public access to disaggregated data that does not require anonymity and/or aggregated data is helpful to support academic and think tank research like we perform at Community Solutions.
Improving data collection will aid in identifying and reflecting gaps in clinical and social supports and help to improve health outcomes for all Ohioans.
One recommendation that we would like to see but did not was insurance reimbursement, including through Medicaid, for all members of a birth support team, including midwives and doulas. [3] Additionally, we would like to see all members of a birth support team considered essential and welcomed into the hospital setting and not force women to choose between their partner or their birth coach during such a stressful time. Women of color experience higher rates of maternal mortality and morbidity but we know that these outcomes can be mitigated by the support of culturally competent birth support staff. [4]
We are incredibly pleased with the blueprint as it not just shows that minority health matters to the administration, but that mattering is the minimum.
- https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html?CDC%5FAA%5FrefVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fracial-ethnic-minorities.html#anchor%5F1595551043298
- https://development.ohio.gov/files/research/P7001.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610709/
- https://safehealthcareforeverywoman.org/patient-safety-bundles/
